POLICIES & PROCEDURES Number: 40-70 Title: Influenza and Influenza-like Illness (ILI) Authorization: Source: Infection Prevention & Control √ SHR Regional Infection Prevention & Date Initiated: May 2007 Control Executive Committee Date Reaffirmed: October 2010 Date Revised: October 2014 Scope: SHR Agencies & Affiliates Any PRINTED version of this document is only accurate up to the date of printing. Saskatoon Health Region, (SHR) Infection Prevention & Control (IP&C) can not guarantee the currency or accuracy of any printed policy. Always refer to the IP&C internal website for the most current versions of documents in effect. SHR IP&C accepts no responsibility for use of this material by any person or organization not associated with SHR. No part of this document may be reproduced in any form for publication without permission of SHR IP&C. Introduction Influenza is a common and very contagious respiratory tract infection caused by Influenza A or B viruses. It is characterized by the following symptoms: fever, myalgia, headache, severe malaise, sore throat, rhinitis, and cough. People of all ages can be affected but influenza is more dangerous in the very young, the elderly and people in poor health due to chronic illness or disability. Antibiotics are not effective since the infection is caused by a virus and not by bacteria. During the influenza season, outbreaks of health care-associated influenza affect clients and personnel in long-term care facilities and hospitals. In some people, influenza can exacerbate underlying medical conditions (i.e., pulmonary or cardiac disease) or lead to secondary bacterial pneumonia. Influenza vaccination is the most effective way to gain protection from influenza and prevent outbreaks. Influenza is primarily transmitted from person to person via virus-laden droplets that are generated when infected persons cough, sneeze, or talk. These droplets can then settle on the mucosal surfaces of the upper respiratory tract of susceptible persons who are near (i.e., within 2 metres) infected persons. Transmission may also occur through direct contact or indirect contact with respiratory secretions, such as when touching surfaces contaminated with influenza virus and then touching the eyes, nose or mouth. The influenza virus may persist for hours particularly in the cold and in low humidity. Adults can spread influenza to others from the day before getting symptoms to approximately 7 days after symptoms start. Children and immune compromised adults can shed influenza viruses for 10 or more days. To protect health care workers, clients and others in the health care setting, individuals who are identified as having symptoms of an Influenza-like Illness (i.e., acute onset of respiratory illness with fever and cough with sore throat, headache, runny nose, muscle aches, extreme tiredness, Page 1 of 5 Number: 40-70 Title: Influenza and Influenza-like Illness or prostration) need to be identified as soon as possible and infection prevention and control measures put in place to prevent transmission. This policy is not meant to be followed for clients with Severe Acute Respiratory Syndrome (SARS) or an emergent respiratory infection that has not been clearly identified. (Refer to Policy 30-30 Droplet Precautions). Policy 1. Use Droplet and Contact Precautions for a client known or suspected to have Influenza-like Illness or Severe Respiratory Illness (SRI). 2. Notify Infection Prevention and Control Professionals of clients admitted with Influenza-like Illness or Severe Respiratory Illness. Purpose 1. To minimize influenza exposure. 2. To detect and contain clusters or outbreaks of influenza. Procedure 1. Implement respiratory hygiene/cough etiquette at the first point of contact with a potentially infected person. Respiratory hygiene/cough etiquette includes: Post visual alerts instructing clients and persons who accompany them to inform health care personnel if they have symptoms of respiratory infection. Provide tissues or masks to clients and visitors who are coughing or sneezing so that they can cover their nose and mouth. Ensure that supplies for hand washing are available where sinks are located and provide dispensers of alcohol-based hand rub (ABHR) in other locations. Encourage coughing persons to sit at least 2 metres away from others, if possible. If crowded conditions exist, ensure the client wears a surgical mask or at a minimum uses a tissue and performs hand hygiene. 2. Identification Nursing notifies Infection Prevention and Control Professionals of clients with or who develop Influenza-like Illness symptoms so they can monitor during influenza season. Infection Control Professionals notify Public Health of inpatients with Influenza-like Illness. Infection Control Professionals notify Occupational Health Services (OHS) about any cluster of clients so OHS can monitor staff. OHS notifies staff clusters to Infection Prevention & Control. 3. Respiratory Hygiene (Respiratory Cough Etiquette) Teach the client how and when to perform hand hygiene. Teach the client how and when to perform respiratory hygiene practices (cover your cough by coughing into sleeve, using tissues, or wearing a mask). Refer to Policy 20-95 Respiratory Hygiene and Cough Etiquette. Teach the client to wear a mask (if tolerated) when health care workers, other staff and visitors are present. Page 2 of 5 Number: 40-70 Title: Influenza and Influenza-like Illness 4. Client Placement Whenever possible, use single rooms for inpatients with symptoms compatible with influenza. When single rooms are not possible, ensure that spatial requirements (i.e., two metres between clients with symptoms compatible with influenza and clients without symptoms) are maintained. Post Droplet and Contact Precautions sign (SHR Printing Services #102107) on the room door indicating the precautions required. 5. Hand Hygiene Perform hand hygiene as per 20-20 Hand Hygiene Policy using either alcohol-based hand rub (ABHR) or soap and water. Remember to ensure the client’s hands are cleansed before and after eating, after going to the bathroom and frequently if the person is coughing and sneezing. 6. Respiratory Protection Wear a regular mask (procedure or surgical) when within two metres of the client. Change mask if it becomes wet or soiled (from the wearer’s respiration or through an external splash). Remove the mask by the straps, being careful not to touch the mask itself, after leaving the room and dispose of in hands-free waste receptacle. Perform hand hygiene after removing the respiratory protection and after leaving the room. 7. Eye Protection Wear eye protection (i.e., visor, face shield) whenever a mask is worn. Prescription eye glasses are not considered sufficient eye protection. Remove eye or face protection after leaving the room and dispose of in either a hands- free waste receptacle (if disposable) or in a separate receptacle to go for cleaning (if reusable). 8. Gloves and Gown Wear gloves and gown for all contact with the client or the environmental surfaces in the room. Gloves and gowns are single use only. Change gloves after contact with infectious material that may contain high concentrations of microorganisms. Remove gloves, then the gown. Untie at the back, pulling forward and turning inside on itself, rolling up and discarding in the laundry hamper in the room. Perform hand hygiene after removing gown and gloves. Avoid contact with the environmental surfaces when leaving the room. 9. Client transportation Transportation of the client to other departments or facilities should be limited to essential diagnostic or therapeutic procedures. Inform the receiving department that Droplet & Contact Precautions are required. Page 3 of 5 Number: 40-70 Title: Influenza and Influenza-like Illness Client should wear a regular mask during transport and be instructed on how to perform respiratory hygiene. For clients who are unable to wear a regular mask, provide tissues for use and instructions on how and where to dispose of them, and the importance of hand hygiene after handling tissues. When leaving their room, the client must have on a freshly laundered gown/housecoat and have cleaned their hands with alcohol-based hand rub (ABHR) or soap and water. Glove for transport of client and when anticipating direct contact with client, a gown is required. Place chart in clean bag or pillowcase and place on client’s lap or bed. Avoid contact with surfaces en route. Use elbow to push elevator buttons. Use clean sheet to cover client. Clean equipment used in the department with a hospital disinfectant. Clean stretcher or wheelchair used with a hospital disinfectant. 10. Visitors Instruct visitors regarding appropriate use of a mask, eye protection, gowns, gloves and hand hygiene as well as visitor guidelines for Droplet and Contact Precautions by providing Droplet and Contact Precautions – Client, Family and Visitor Information (SHR Printing Services #102927). Visitors with Influenza-like Illness must not visit while symptomatic. Close relatives of critically ill clients are exempt, but they must wear masks upon entry into the facility and perform hand hygiene before and after the visit, which must be restricted to that client only. 11. Client and family teaching Clients should understand the nature of their infectious disease and why precautions are being used to prevent the transmission of disease to other clients, family and friends during their hospital stay and upon their return to the community. Provide